14 May, 2006

For those of you following this series (which has been on a long hiatus), I will soon be posting the next chapter. The article included below provides some interesting background, not only about the scene that sparked a chain of events which changed our office forever, but about the personality of the pathologist I worked for during four of my five years as an investigator.

I did not read this article until recently. It was published during a time in which our office was the subject of much media attention, locally and even nationally. Those of us involved grew weary of seeing articles, interviews, and reports about our office on a daily basis and eventually began to avoid reading them.

This one I missed. Now, years later, I read it with not a little nostalgia and some degree of awe - and a bit of sadness as well.

What I appreciate most about this article is the way journalist Ivan Solotaroff captured the very essence of this intriguing man who I have always found so difficult to describe.

"Dead Reckoning"

By Ivan Solatoroff From the July 1999 issue

Philadelphia Magazine

Dimitri Contostavlos, the medical examiner of Delaware County, rifles the top left drawer of his desk for the vertebra of a man he autopsied 30 years ago. It looks a bit like a fossil a small, flat circle of bone in a yellowed Ziploc though the pride and mystery on Dimitri's face as he hands it across the desk to me speak otherwise. "This is the body's uppermost vertebra," he says. "Called Atlas. He on whose shoulder the world rests."

Some leave their names on mathematical constants or hospital wings. The dark secret of this disk a murder is Dimitri's bid for immortality. Using the Phillips screwdriver of his Leatherman, a Swiss Army-type tool he bought recently and uses often, he points to a tiny fracture on one side: what has become known as the "Dimitri lesion." With great clarity and a vestigial South London accent, he explains how it helped him to declare that the bone's original owner died not from stroke, as had been assumed, but from a blow to the side of the neck. "Of the karate-chop variety," Dimitri concludes, flashing one of his agreeably didactic smiles as he returns the bone to his desk. "The neck is of huge importance to my work, you know. All mammals go for it when they want to kill. And that includes humans lacking a knife or a gun."

The neck is also the area that gave Dimitri his nickname: "Quinsy." That's not a typo of the TV M.E. played by Jack Klugman. "'Quinsy,'" Dimitri explains, "is an abscess of the neck, caused by staph or strep. It means I am, or can be seen as, an extreme pain in the neck. Particularly by those who do not want to hear what I have to say."

Some particularly unwanted words vaulted Dimitri into the national spotlight this past February: a report that five popular girls at Penncrest High School, all model students, were not the innocent victims of a freak highway crash on a stretch of U.S. 1 called Dead Man's Curve, as was originally and widely reported. They were, rather, the latest statistic in what the National Inhalant Prevention Coalition, a nonprofit organization, calls "a silent epidemic": huffing, the late-20th-century variant of glue-sniffing, currently America's fourth most common form of substance abuse. Dimitri's findings, published with a clear eye to alerting the county to the epidemic, led mostly to months of extreme bitterness. The parents of the girls refused to accept the findings. Dimitri, in turn, still refuses to accept their denial.

Dimitri's corner office, sandwiched between Delco's library headquarters and the county morgue, is in a peaceful complex set far behind the Fair Acres Hospital in Lima. The buildings are newly refurbished but so institutional and ugly that they look old, backed by a thick stand of hardwoods that would probably seem beautiful if they were anywhere else. As you drive up to the largely empty parking lot, there's simply no doubting you've come to the end of the line.

In a darkened office next to Dimitri's, his fellow examiner, Ed Wilson, is flipping through slides of a severely damaged brain. "An epileptic's," Dimitri advises me. "Went into seizure in hospital while awaiting treatment for an earlier seizure suffered at home. We're trying to determine which of the two led to the fatality, which may or may not lead to an investigation for negligence followed, doubtless, by a lawsuit. We're thought of as a branch of the police, but much of what we do here is civil, rather than criminal, investigation." Delco, population 550,000, looks into some 1,200 deaths a year. Only half make it to Dimitri's office, and of those, only half will undergo autopsy. "It averages at one a day," he says. "Today, none, so we can have a nice long lunch."

The morgue, at the end of which, is dominated by the autopsy room, which looks like an industrial kitchen. Colanders and sieves, used to filter earth and gravel from crime scenes, share the stainless steel shelves with ladles, saws, Adolph's Meat Tenderizer (whose purpose I don't ask after), a 10-inch chef's knife Dimitri found so good for cutting meat and vegetables at home he brought it to work. Over the autopsy table is a large greengrocer's scale. The refrigerators are in the next room: four individual shelves and a large walk-in, which is much harder to walk into than I had imagined. Currently inside are an unclaimed nonagenarian, a fetus that had been dropped into a tulip bush by the 15-year-old mother, and two others I'm happy to learn no more about: "Wisdom," wrote Horace, "sets bounds, even to knowledge."

Those bounds, one quickly learns, are the deep structure of this place and of the controversies that seem to constantly surround Dimitri Contostavlos. Death may well be our last taboo: that which cannot be looked at directly. Dimitri, who seems to revel in occasionally having the weight of the world or at least of Delco on his shoulders, has no compunction about making us look at death without flinching or altering the details with inexactness, secrecy, symbolism. Whether autopsying a mummified baby found wrapped in newspaper dated 1938 in the crawlspace of a Ridley Township home, or a retarded woman who died in her bathroom giving birth to a baby she hadn't known she was carrying, Dimitri has a gift for dispassion, plus a ready finger to point at anyone he feels has either bungled his job or is dangerous to the public weal. The list can range from policemen, social workers, politicians and members of his own eight-person staff to Jack Kevorkian, whom he calls an "exhibitionist and ego merchant," and chiropractors: "Dangerous people," he tells me, noting that I twist my neck often to relieve stress. "That cracking sound you make when you do that," he asks. "Do you imagine that it provides you with some sensation of relief?"

His pet peeve is coroners. Dimitri, by contrast, is a medical examiner, of whom there are fewer than 250 in America. "The very title of these colleagues," he pronounces, "speaks of their archaic, anachronistic institution. Coroner. From corona, or crown. A man who did his majesty's bidding, everything from estates to smuggling. Your average American coroner, an elected man, is a part-timer who averages $40,000 to $50,000 per year. His most common occupation? Doctor? Undertaker. His reason for being there? Politics. His talent, or lack thereof? Utterly random."

No one disputes Dimitri's talents certainly not his employers, who year to year have paid him the highest salary in the county but even his admirers admit he can be difficult. As his colleague Halbert E. Fillinger M.E. of Montgomery County and the state's only other forensic pathologist puts it, "He is a hair shirt."
Dimitri, who moved seamlessly from medical school in Dublin, Ireland, to forensics (which is, simply, the juncture at which law and medicine meet), knew from the first he had "zero patience for the so-called human side of medicine. The bedside manner. The patient in denial. Hysterical Mrs. Smith with her thrice-monthly appointments and nothing remotely the matter with her. This is 50 to 90 percent of a practitioner's work, you know. What I do, as your health enthusiasts like to say, is 100 percent organic. You're not a vegetarian, I trust?" he asks, scratching his head as we head for Bobby's in Newtown Square, his favorite seafood restaurant. "Utter rubbish."

One learns to take these pronouncements in stride with Dimitri, who becomes a kinder, gentler man with each step he takes from the morgue's front door. More precisely, he becomes a more interesting man with each sentence: a man of parts no morgue puns intended. The son of a prosperous ship's broker, Greek-born but raised a Londoner, he is what they used to call a cosmopolitan. After a truly English unhappy childhood spent in boarding schools and public schools in Sussex and the Lake District, he was privileged to see the blackouts of the Second World War from hotels in Maidenhead and a Welsh coastal town whose name he evokes with great elan: Devil's Bridge.

He failed to get into a good university in England, however, and wound up at Trinity College, Dublin. He enjoyed it immensely: "I'd never realized what a xenophobic, imperialistic race the English were until I went to Ireland," he says. "Once there, I became quite an Anglophobe and determined never to return." He credits a lecturer in forensics at Trinity, Jackie Wallace, with his straight line to the profession: The current M.E.s of Belfast and Dublin were also in the class. "With that decided," Dimitri says, "it was only a question of which English-speaking land I would emigrate to. I'd been lucky enough to marry an Irish girl" his wife, Ursula "and in those days, the U.S. quotas were lax on northern Europeans."

He wound up at the M.E.'s office in Camden, New Jersey ("the best-paying job available"), and spent 16 years working his way up between jobs in Chappaqua, New York; Baltimore; and Dade County, Florida (where he discovered the Dimitri lesion), then Philadelphia. He moved into his present job in 1979, when Delco, dissatisfied with the coroner system it had always used, created the position. He held it single-handedly until last year, when he told the county he wanted to take a pay cut and create a second M.E. slot, now filled by Ed Wilson. He admits to having no patience for the arts he watches few movies and finds interest in poetry and novels almost baffling but says he can't recall an hour that he's spent idle. He grew up skeet shooting and snipe-hunting, became fascinated with flying gliders, golfing and, currently, with fishing and gardening "roses, in particular." He has a passion for gadgets mostly manual stuff like his Leatherman tool or the huge light microscope that occupies half his desk, but he's slowly warming to technology: a cell phone he makes show of being unable to operate, until a D.A. from Cherokee County calls about a case that might involve the Dimitri lesion. He also has a Sharp hand-held computer he's forever leafing through storage areas like Cracked Lung Studies, Unremembered (names of friends and celebrities he always forgets), and Palindromes, for which he has a flair a recent composition spells out Dimitri's passion for the tales that dead men tell: Evil all its sin is still alive.

A brief autopsy of Dimitri's C.V. simply to help understand this complex man and his periodic skirmishes with the public: His disdain for the English notwithstanding, Dimitri is a model specimen of that most British of types, the perfectionist hobbyist. Endlessly curious and relentlessly pedagogical, he's a man who works hard to develop an opinion, which once held will be forever the truth. It extends to his work and the simple language of his reports. It's a rare doctor who doesn't hide behind jargon to create an expensive allure or simply to hide the brutality of what he has to say. Dimitri, if anything, hides in the brutality and in the nakedness of his verbiage. After 33 years, he must know how brutish it might seem to the parents of a teen who don't particularly want to compound their grief with hearing about suicide. Or as with his 1984 autopsy of a young Navy man who died in Australia and was brought back by suspicious parents that there was in fact no neglect or violence, simply a severe asthma attack.

Mention the controversies his bluntness sometimes evokes, however, and Dimitri seems baffled. He refers back to his distaste for the "human side" of medicine, or simply says it doesn't pay to obfuscate. "In the Philly office," he says, "if there was an issue of a suicide being denied burial in hallowed ground, we'd put on the death certificate, Killed himself while balance of mind disturbed. I just had one, and I don't remember if it was out of rote reflex or just to make them feel better, but I wrote that phrase again. Man, they were irate: 'How dare you! He had no history.'" He shrugs his shoulders helplessly.
Dimitri was on vacation in Greece the Saturday afternoon 17-year-old Loren Wells of Media, her friends Tracy Graham and Rachel M. Lehr, also 17, and Shaena E. Grigaitis and Rebecca J. Weirich, both 16, went shopping for prom dresses in Wells's red Chevy Corsica.

Shortly before 4:30, heading north on U.S. 1 at 65 to 75 m.p.h., blasting a Black Street and Mya cassette, Loren Wells lost control of the Corsica. Veering first into the right shoulder, she swerved across lanes into the berm dividing the four-lane road. She appeared to regain control but within seconds had swerved back again, this time into oncoming traffic. She hit a utility pole, cut back across her side of the road, and slammed head-on into a tree on the right shoulder at full speed. The impact sent the engine block through the front seat, killing her and three other girls instantly. The fifth, Tracy Graham, died at HUP several hours later.

The autopsies, conducted in Dimitri's absence by Ed Wilson, raised no red flags. Among the items in the Corsica, the mechanic handling the wreckage did find a can of Duster II a spray used to clean computer keyboards. He gave it to state police, who brought it to the M.E.'s office. Its significance went unrecognized, however, and it was returned to the mechanic.

Wells's blood work, sent to the state lab in Lyonville, showed no signs of alcohol abuse, which was no surprise. The girls were known as clean-living hardly the types to be drinking on a Saturday afternoon. The pathos was ratcheted up days later, when a video the girls had made a week before the accident warning of the evils of smoking and drinking and drug abuse on the road was shown on television.

Then Dimitri returned from Greece. Preliminary findings of a freak accident were ready to go out, but something about the report didn't smell right to him. A phone call to Corporal Fran Winkler, the Accident Reconstruction man from the Pennsylvania State Police, heightened his doubts. For one thing, he knew the stretch of U.S. 1. Halfway between Wawa Headquarters and the Franklin Mint, less than five miles from his office, it was called a "dead man's curve," an appellation repeated ad nauseam in the media for what was actually an easily driven uphill grade. As he learned from Corporal Winkler, the Corsica had been out of control for almost half a mile. "After 33 years of road deaths," he says, "you learn that bizarreness, barring extreme youth or agedness, means substance abuse."

When Wells's toxicology report came back from Drugscan, the Willow Grove lab he routinely uses, Dimitri reopened the case. One of the principal tools for analyzing blood is a gas chromotograph, a centrifuge-created graph of specific trace elements. Confirming the state's blood lab, Well's chromotograph showed no sign of ethyl alcohol, but it had a large, highly unusual spike for methyl alcohol. Mark Lichtenwalner, a toxicologist at Drugscan, was confounded by the result: "I think it's propane," he advised. Dimitri was piqued.

Two days later, Dimitri's investigative supervisor learned about the can of Duster II and had it brought back to the M.E.'s office. Dimitri read the contents, then got back on the phone with Lichtenwalner and asked if the spike could have been created by difluorethane a variant of freon. By the time the positive results came back, Dimitri, who had never heard of huffing, had learned all about the "silent epidemic."

"The chemicals for it," he says, "are in hundreds of everyday products. Paint thinners, cleaning fluids, marking pens, aerosol cans, bottles of Wite Out. Kids soak their sleeves in solvent and sit around sniffing it. Or with cans like Duster II, they invert it, then release the substance, which has become liquid. In cars, they lay it on dashboards then huff while they sit there or, worse yet, while they drive."

He'd also put together a chronology of the afternoon, tracked down the woman in the Springfield Mall who had sold Shanna Grigaitis the can of Duster II (Shanna had tried to buy three cans but only had enough money for one), then performed the acid test on himself. Opening a can of the cleaner in the back of his car with the windows closed, he breathed deeply for some five minutes, then emerged and had his blood tested. It confirmed that the girls could not have become exposed to second-hand fumes. No accident.

He called Corporal Winkler and asked if he agreed that the Duster II had been the "agent of destruction."

"One hundred percent," said Winkler, who added that the State Police, who were of course quite familiar with the "silent epidemic," also came to that conclusion.

"Should you release the information," he asked, "or should I?"

"Why don't you," said Winkler.

The parents of the five girls, accompanied by a state policeman, came to confront Dimitri the following evening. Dimitri will speak freely on almost any subject, but he declines to discuss the meeting, except to say it was "quite emotional at times." He does admit, however, to a prior run-in in an unrelated incident with one of the girl's parents. "It came after an autopsy report that I issued two years ago," he remembers as he takes his first bite of blackened salmon at a back booth in Bobby's. "Another death of a teen at the wheel, this time also involving the passenger's permanent brain damage. As I recall, it made news largely because the death occurred the same weekend as Princess Di. Good food, eh?" Dimitri draws his knife in a long motion across the plate, separating the salmon filet from the bone. "Princess Di," he says. "There's another open-and-shut case of driver impairment."

The parents of the Penncrest girls issued a written statement: "[I]t seems clear to us that there is inconclusive evidence that our children intentionally abused the cleaning agent involved." They added that the substance had been airborne, then declined further comment, asking that they be allowed to "resume the healing process."

Dimitri recalls that Channel 6, reporting on the challenge to his findings, ended with the words, "But the damage is already done." Nothing could have made Dimitri angrier. "The damage," he says, "was done when a Chevy Corsica hit a tree at a speed exceeding 65 mile per hour. Listen, I'm a physician, and I understood the importance of the healing process that the kids' parents raised. And though I understand that denial might be part of that healing process, at some point, it doesn't change the truth of my findings or represent them as the intrinsic danger."

And on he goes. I've spent five hours with Dimitri, riveted to almost every word. Suddenly, however, I find myself almost unable to listen to what he has to say. It's not that it seems repugnant, or wrong, or boring. My mind simply won't focus on his words. As he speaks, I recognize words, fragments even, but the general thrust is completely lost on me. "This is taboo," I tell myself, fascinated by the cognitive dissonance.

"But let's speak of something else, finally," he says. "You say your wife gardens. Have you bought her a Roto-Tiller?"

"No, we're going to rent one."

"Rent one!?" he bellows. It's the first sound of genuine anger I've heard, despite the long harangue. "Two hundred bucks!? For endless weeks of domestic peace? C'mon man," he says, getting that immensely agreeable and didactic smile on again. "Get your head on straight."